Managing Concussion at School

Our concussion experts recommend that school staff partner with the student and the student’s family in a team approach to create a smooth and successful transition back to school. Often a meeting with the student’s teachers and the guidance counselor is needed to discuss the student’s symptoms and to arrange academic accommodations.

General symptoms of concussion

Concussion symptoms can occur immediately, within a few hours, or may not be noticed for a day or two after the injury, especially if the signs are subtle. Sometimes symptoms may not be obvious until cognitive or physical exertion occurs. Some symptoms might resolve fairly quickly, but others may persist for much longer. The number and severity of symptoms, the speed of the recovery, and the impact of symptoms on academic functioning will be different for each student. 

Concussion symptoms at school

After a student suffers a concussion, they may have many different concussion symptoms that affect their ability to perform well in the classroom. For example, the student might:

  • Get tired easily in class and over the course of the day
  • Be bothered by bright fluorescent light in the classroom or loud noise in the cafeteria
  • Be easily distracted
  • Have trouble doing more than one thing at a time, such as listening to the teacher while also taking notes
  • Take longer and need more repetition to learn new material
  • Remember something one moment but have difficulty remembering it later
  • Not be able to recall new information learned since the concussion occurred
  • Be easily overloaded, especially with a full course load
  • Read more slowly due to difficulty with concentration and comprehension
  • Have a headache that develops or worsens with concentration
  • Feel dizzy after sudden movement or lose her balance more easily
  • Have trouble organizing and remembering homework
  • Lose track of time
  • Get lost or have trouble finding her way around
  • Get frustrated more easily, especially if very symptomatic

In general, concussion can affect a student’s cognitive stamina, limiting the amount of time they will be able to spend on school work. This is because the injured brain is already working to repair itself and additional tasks overload the system. As a result, the student gets tired more easily and symptoms may temporarily worsen.

The student’s vestibular function may also be affected. This is the brain’s ability to visually track and focus — skills needed throughout a student’s day. As a result, reading, note taking, test taking and walking through a busy school hallway can become a real challenge. 

In addition, students with a previous history of developmental disabilities (ADD, ADHD) or learning disorders (dyslexia), mood disorders (anxiety or depression), vision disorders or migraine headaches, can often have more prolonged symptoms after a concussion. Their underlying conditions may also be magnified after concussion. These effects can last for months after a concussion has occurred. It is important to watch out for these symptoms after a concussion and ensure students with concussion have the support they need to continue to be successful in school.

How school staff can help students with concussion

Academic difficulties may continue for quite a while after concussion, and can contribute to poor school performance and psychosocial problems for the student. As a result, teachers, school nurses and other school staff play an important role in the student’s recovery from concussion. 

Changes in thinking, learning and behavior after concussion can be subtle, present differently for each student, and may be hard to detect initially. Teachers’ sensitivity and understanding toward the student is critical. Teachers may want to think of ways to monitor progress and focus on improvements. Visit "Adapting the Classroom for Concussion" to learn about academic accommodations and for tips to address special needs and deficits caused by concussion.

While a student is still recovering from a concussion, another jolt to the head can cause another concussion and prolong and even worsen the symptoms. Therefore, it is especially important to ensure the student does not participate in any activity that would unnecessarily increase the risk for another concussion. This would include contact and collision sports, but also gym class and sometimes recess. As symptoms improve, students should be encouraged to return to non-contact physical activity first. Read more about Return to Play for students with concussion.

If after informal academic accommodations are in place, the student is still struggling with his school performance, we recommend that a more formal academic plan, such as a 504 Service Plan Agreement, be put in place. The family may want to involve the state’s school re-entry program for brain injured children, such as BrainSTEPS in Pennsylvania.

What can the school nurse do to help?

The school nurse plays an important role by helping to monitor the student’s symptoms and recovery from concussion.

Although generally rare in the first few weeks following a concussion, there may be medications prescribed to treat post-concussion symptoms and the nurse may help to manage these medications in the school setting. When the student needs cognitive rest or when symptoms occur during the school day, resting in a quiet room, like the nurse's office, often helps symptoms improve.

Next Steps